Cochrane and capacity
building in low- and middle-income countries: where are we at?
- <=
span
style=3D'font-size:12.0pt;font-family:"Times New Roman","serif";mso-fa=
reast-font-family:
"Times New Roman";mso-fareast-language:EN-GB'>By: Taryn Young, Paul Garner,
Tamara Kredo, Lawrence Mbuagbaw,
Prathap Tharyan &
Jimmy Volmink
- <=
span
style=3D'font-size:12.0pt;font-family:"Times New Roman","serif";mso-fa=
reast-font-family:
"Times New Roman";mso-fareast-language:EN-GB'>On: November 01, 2013, 06:00=
![3D"thumbnail](3D"Cochraneandcapacitybuildinginlow_files/image001.jpg")
"=
;A
painstakingly primped coiffure" – that is how a development writer described
capacity building recently, illustrating development specialists' expansive
jargon around a simple concept: investment that leads to individuals or
institutions becoming self-sufficient rather than dependent.[1] Usually used in relation to low- and
middle-income countries (LMICs) attaining a level of competency they have n=
ot
yet reached, it is a rather old-fashioned concept laden with value judgemen=
ts,
but it is probably here to stay.
So wh=
at
does capacity building consist of? To start with, it is a lot more than
training. The endgame for capacity building in health research is individua=
ls,
groups, and institutions in LMICs that are globally competitive: carrying o=
ut
the best possible science to generate new and important research findings;
using research effectively to guide research priorities as well as policy; =
and
promoting the demand for research that addresses the needs of their own
countries.[2] The Cochrane Collaboration provides a
brilliant vehicle for this development, conducting systematic reviews,
promoting the use of research evidence, and enhancing research capacity thr=
ough
sustainable networks.
In the
world of evidence synthesis, Cochrane's ethos helps build capacity to carry=
out
reviews. The principle of working in inclusive teams, modelled by Iain Chal=
mers
in pregnancy and childbirth, was at the heart of ensuring supportive mentor=
ing
and engagement with a broad, non-elitist community from the outset. The
Collaboration established multiple efforts to invest everywhere in doing re=
views
because, let's face it, 20 years ago there was a worldwide capacity gap in
research synthesis. So the highly decentralised nature of the Collaboration,
built on principles of fairness and equity, was an important grounding. In a
narrow sense, part of capacity building in The Cochrane Collaboration is
ensuring independence of individuals and groups of people in LMICs completi=
ng
high-quality Cochrane Reviews, with all the necessary technical and
methodological expertise. That in itself is an important goal.
![3D"Cochrane](3D"Cochraneandcapacitybuildinginlow_files/image003.jpg")
Iain Chalmers and Jimmy Vo=
lmink
celebrating Cochrane's 20th anniversary
at the Cochrane Indaba, Cape Town, South Africa, May 2013
The
Cochrane Collaboration's vision "that healthcare decision making
throughout the world will be informed by high-quality, timely research
evidence"[3]
implies that capacity needs to be enhanced at another level – helping
decision-makers find, appraise, interpret, and consider the use of systemat=
ic
reviews. The Collaboration trains people to understand and interpret review=
s,
generates advocates for evidence-informed decision making, and supports age=
nts of
change. While in the UK systematic reviews are deeply embedded in the whole
health system, this cannot be said for many other countries, where traditio=
nal
models still abound. Now with multiple initiatives worldwide in research
translation, a clear focus and embedding of research translation in
institutional systems will be important if funders are to get their money's
worth.[4] The
Collaboration is way ahead of many groups in this area. Authors are
contributing to research translation simply by preparing scientifically val=
id
Cochrane Reviews, and Cochrane authors and editors provide a core and unique
resource in evidence synthesis globally and nationally, able to advise
multilateral agencies, governments, and other decision-makers in the use of
best evidence in policy and practice.
Even =
more
broadly, Cochrane's ethos of rigor, scientific integrity, collaboration, and
global networking builds the competence of individuals, groups, and
institutions in high-quality, relevant research. It is remarkable how good
Cochrane Collaboration training is, both directly, for sustaining the learn=
ing
of research skills, and indirectly, by linking people and institutions into=
a
supportive global research network of many of the best methodologists and
leaders. By participating in Cochrane Reviews on important topics, smart
authors early in their career can gain international recognition without hu=
ge
grants or projects. The Collaboration's network provides social capital and
support. It also engenders important attitudes around rigor, partnership, a
focus on outputs, and value for money. Authors of systematic reviews learn =
the
strengths and weaknesses of primary studies, and in so doing, are in an
informed position to themselves carry out high-quality relevant primary
research.
Manag=
ing
and financing capacity building needs care. The Collaboration has valued
individual effort and enthusiasm, and that has largely avoided the perverse
incentives associated with competitive grants and academia in general. But
capacity building and Cochrane Reviews both need investment, particularly as
carrying out reviews becomes more demanding. In our own experience as part =
of a
UK Aid programme-funded consortium that supports Cochrane Review production,
promotes their use, and is committed to capacity building, we have developed
management approaches that have helped us and, in the spirit of the
Collaboration, provide a base for others to build on and develop. With supp=
ort
from a strong advisory committee, we have set up a decentralised management
structure to allow responsive funding with partners in the Consortium.[5] T=
hese
partners have discretion on effective use of funds to achieve the programme
outputs – to 'get the job done'. Governance is through work plans developed
within the explicit strategic priorities of the whole Consortium and negoti=
ated
within a management system in the Consortium framework working in line with=
the
expectations from the funders. The work plans are formalised as output-based
contracts. Outputs are monitored six-monthly, and the contracts are adjusted
when appropriate. This active, transparent management with a focus on
high-priority review topics and with performance and year-on-year funding
dependent on outputs provides a flexible and effective framework and high v=
alue
for money. With review engagement, networking, and small scale audit and
research projects, the grant aims to build institutional competence,
conceptualised around knowledge, skills and attitudes to research, it build=
s research
independence, which is the endgame we all seek (Figure 1).
![3D"http://www.thecochranelibrary.com/SpringboardWebApp/userfiles/ccoch/=](3D"Cochraneandcapacitybuildinginlow_files/image005.png")
Figure 1.
www.e=
vidence4health.org
RPC =3D Research Programme Consortium
For t=
he
Collaboration as a whole, a strategic approach to capacity building makes
sense. In particular, building on the existing centre and branch infrastruc=
ture
and expertise, and building on current authors and their institutions is
important, as well as drawing in new individuals, groups and institutions t=
hat
sign up to the principles and high standards expected. Helping prospective
Cochrane authors to engage with their audience, to be responsive to current
information needs, and to become familiar with existing systematic reviews =
is
central to identifying relevant new review topics. This, together with
promoting the use of best evidence in decision making, should be done throu=
gh
maintaining Cochrane principles, and high standards of quality, while advan=
cing
sustained efforts to build infrastructure, lobbying for institutional suppo=
rt,
and providing technical, methodological, and financial support.
And f=
or
all the experienced authors and editors in the Collaboration – you need to =
be
part of this: how many people in LMICs have you supported in conducting a
Cochrane Review in the last 12 months? Mutual support and strong networks a=
re
what makes Cochrane powerful, so let's use them even more in fulfilling what
the development specialists like to call 'capacity building'.
Taryn
Young1, Paul Garner2, Tamara Kredo3, Lawre=
nce
Mbuagbaw4, Prathap Tharyan5,
Jimmy Volmink6
1Taryn Young (tyoung@sun.ac.z=
a),
Centre for Evidence-based Health Care, Faculty of Medicine and Health Scien=
ces,
Stellenbosch University, and South African Cochrane Centre, South African
Medical Research Council, South Africa; 2Paul Garner (pgarner@liv.ac.uk), E=
ffective
Health Care Research Consortium, Department of Clinical Sciences, Liverpool
School of Tropical Medicine, UK; 3Tamara Kr=
edo
(tamara.kredo@mrc.ac.za), South African Cochrane Centre, South African Medi=
cal
Research Council, South Africa; 4Lawrence M=
buagbaw
(mbuagblc@mcmaster.ca), Centre for the Development of Best Practices in Hea=
lth,
Cameroon; 5Prathap Tharyan
(prathap@cmcvellore.ac.in), South Asian Cochrane Network & Centre,
Christian Medical College, Vellore, India; 6Jimmy Volminck (jvolmink@sun.ac.za), Centre for Evidence-ba=
sed
Health Care, Faculty of Medicine and Health Sciences, Stellenbosch Universi=
ty,
and South African Cochrane Centre, South African Medical Research Council,
South Africa.
How to
cite: Youn=
g T,
Garner P, Kredo T, Mbuagba=
w
L, Tharyan P, Volmink J.
Cochrane and capacity building in low- and middle-income countries: where a=
re
we at? [editorial]. Cochrane Database of Systema=
tic
Reviews 2013;11:ED000072.
dx.doi.org/10.1002/14651858.ED000072
References
1.
2. Bates I, Akoto
AYO, Ansong D, Karikari P, Bedu-Addo G, Critchley J,=
et al. Evaluating health research capacity building: an
evidence-based tool. PLoS Medicine 2006,3(8):e299. <=
span
style=3D'color:blue'>dx.doi.org/10.1371/journal.pmed.0030299
3. The Cochrane Collaboration. =
About us. www.cochrane.org/about-us
(accessed 30 October 2013).
4. Chinnoc=
k
P, Siegfried N, Clarke M. Is evidence-based medicine relevant to the develo=
ping
world? PLoS Medicine 2005,2(5):e107. <=
span
style=3D'color:blue'>dx.doi.org/10.1371/journal.pmed.0020107
5. Effective Health Care Resear=
ch
Consortium.
Compe=
ting
interests: TY
co-ordinates the work of the Effective Health Care Research Consortium (EHC=
RC; www.evidence4health.org)
in the African region and heads the Centre for Evidence-based Health Care (=
www.sun.ac.za/cebhc)
at Stellenbosch University, South Africa; one of the Centre's aims is to bu=
ild
and enhance capacity in evidence-informed decision making. TY is also emplo=
yed
by the South African Cochrane Centre (www.mrc.ac.za/cochrane)=
as
a consultant to support training and other Cochrane initiatives. PG is dire=
ctor
of the EHCRC, which receives money to increase the number of evidence-infor=
med
decisions by intermediary organisations that benefit the poor in LMICs. The
funder assesses him and the Consortium against outputs that include Cochrane
Review production and capacity building in LMICs. PG is also the co-ordinat=
or
of a WHO Collaborating Centre for Evidence Synthesis for Infectious and
Tropical Diseases (UNK234; apps.who.int/whocc); one of the Centre's ai=
ms is
to help WHO build capacity in research synthesis. TK is employed by the Sou=
th
African Cochrane Centre and is one of the African partners receiving support
from the EHCRC to support evidence synthesis, capacity development, and
evidence use in Africa. One of the Centre's mandates is to support Cochrane
Review authors to initiate, complete, and disseminate their Cochrane Review=
s.
LM works with the Centre for Development of Best Practices in Health (www.cdbph.org)
in Yaoundé, Cameroon, a partner to the EHCRC, and receives payment for work
that aims to produce summaries of health evidence and improve stakeholder
capacity to use evidence in health care. PT is employed by the Christian
Medical College at Vellore in South India. He is Director of the South Asian
Cochrane Network and Centre (www.cochrane-sacn.org),
which has received funding for capacity-building activities from many
non-commercial organisations involved in health care and health policy; this
funding has facilitated research synthesis activities, including the EHCRC.
Since August 2012, PT has been a recipient of The Cochrane Collaboration's
Global Capacity Building Initiative, which partly funds his salary for a
two-year sabbatical from his regular employment. JV has been an ECHRC partn=
er
for many years. He is Dean of the Faculty of Medicine and Health Sciences at
Stellenbosch University, Director of the South African Cochrane Centre, and=
a
member of the Academy of Science for South Africa, which aims to generate
evidence-based solutions in response to high-priority national problems.
Image
credit: The
Cochrane Collaboration
Feedb=
ack: Please contact David Tovey, Cochrane Library Editor in Chief, w=
ith
feedback on this editorial and proposals for future editorials.
Keywords:
Copyright © 2013 John Wiley & Sons, Ltd. All rights reserved